PRUDENTIAL USE OF ANTIBIOTIC IN CHILDREN
PRUDENTIAL USE OF ANTIBIOTIC IN CHILDRENBLOK 26
The War of Germsevery child with fever needs antibioticsThe
concept of prescribing antibiotics that has been squandered2000 BC
: makan akar dan daun ini !!
1945 : pil itu kurang manjur, gunakan penisilin
1955 : waah, kuman resisten, minum tetrasiklin
2007 : wah dan wah dan antibiotik yg kuat
20...... - germ winsss .... Minum akar ini !! Minum daun ituu
!!!!
Component of Treatment
Antimicrobial agents are among the most commonly prescribed
drugs.The major impact on control of most bacterial
infectionsConcerns that unnecessary use is compromising their
beneficial effectGeneral principles of the treatment of
infectionBasic principle of prescribing antibiotic Clinical
asessment Clinical evaluation should define the anatomical location
and severity of the infective process.Although such diseases may be
caused by wide variety of organisms, the range of pathogens are
usually limited.The pattern of susceptibility reasonably
predictable.Permits a rational selection of chemotherapy in the
initial management of such infectionsStep 1Clinical
asassmentAccurate physical examination is necessary to identify the
location of infection and to define antibiotic prescription
Step 2 Look for other issuesFactors to assist antibiotic
selection indication for antimicrobial agent PK/PD that are
associated with a particular antibioticCost effectiveness of
antibioitc selectionMonotherapy or combinaitonCriteria in
antibioitic selection Antibiotic classes & agentsBacterial
Basics14Antibiotic classes
Narrow and broad spectrum antibioticsNarrowAim to specific
bacteri confirm
Broad spectrumUnknown etilogyEmpriricalPotential serious
bacterial infectionMultiple antibioitc
Narrow and broad spectrum --> expire??Location, etiology, and
susceptibility
Mono vs CombinationMono or combinationMonotherapy : One
antibioticCombination : two or more antibioticsAntibiotic
combinationEmpiric therapy of potential serious infectionMulitple
causative agentReduce toxicity and resistencySinergy or
additiveUnappropriate antagonist, adverse reaction >>, cost
>>
Common antibiotic combinationAntibiotic
administrationOrali.vWhen give iv?
Probable Empiric therapyFlowchart of bacterail infection
treatmentLaboaratory assesmentFew infective condition present a
typical picture with a definitive clinical & microbiological
diagnosis without lab. examWhenever possible a clinical diagnosis
should be supported by laboratory confirmation.Strong clinical
suspected, therapy should be given as soon as possible; while lab
assessment should be takenSerological test is important to antigen
detection
Treatment evaluation
Antibiotic therapy failureInaccurate doseInaccurate antibiotic
selectionNecrotic inflammation areaOther infection sourceWrong
diagnosis
Fight smarter not harder
Antibiotic stewardship
The CDC Campaign to Prevent Antimicrobial Resistance in
Healthcare settings: 4 Strategies of the Campaign Thank you
